Video Transcript:

[INTRODUCTION] HOST:

Welcome and thank you for choosing Penn Orthopaedics for your Joint Replacement Surgery. The information in this presentation can make a big difference in how quickly and easily you get back to your normal life after surgery. So, I'm going to walk you through exactly what you can expect before, during and after your upcoming joint replacement surgery.

Along with your Penn Orthopaedics team, I'll show you how to prepare yourself and your family for your stay at Penn Presbyterian Medical Center. We'll discuss the importance of following the guidelines set by your doctors and nurses. And help you understand what your recovery will be like.

The more you understand joint surgery and your rehabilitation, the better we can work as a team to get you back to an active lifestyle – faster. And just so you know, all of the information in this presentation is downloadable, so there is no need to take notes. Just sit back, relax, and take one step closer to a life with pain-free joints.

[WHAT’S A JOINT] HOST:

You’ve probably been suffering with joint pain for a while now. And you might want to know exactly what is going on inside your aching joint. To learn more, let's ask Dr. Garino, an Orthopaedic surgeon here at Penn Medicine.

DOCTOR:

Hi I'm Dr Garino an Orthopaedic surgeon at Penn Medicine. What is a joint? Well a healthy one looks something like this. It's where two bones meet and connect through a series of tissues – muscles, ligaments, tendons and cartilage. When working properly our joints allow us to move without pain.

But joints can also get damaged. Excessive exercise, injury, even arthritis, can turn a healthy joint into this [Doctor to briefly review images of damaged knee and hip joints]. Here you will see the cartilage - it's torn, damaged, or simply worn away. Without this healthy connective tissue, bones begin to grind together and cause the pain, stiffness and inflammation you're feeling now. Joint surgery will relieve the pain caused by a damaged joint. It will also restore motion and help you get back to an active lifestyle. [Doctor to briefly review the mechanics of the hip and knee replacement surgery]

Here's how it works... With total knee replacement surgery, your surgeon will go in and resurface both sides of the knee, removing the bone and cartilage to create surfaces that can accommodate the implant perfectly.

If you're having a partial knee replacement, only the damaged part of the knee is removed. If you are having hip replacement surgery, it’s a similar idea. When a hip replacement is performed, the bone and cartilage on the ball-and- socket hip joint is removed. An artificial hip replacement implant is then placed in to function as a new hip joint. Your new knee or hip is designed to function similarly to your old one, except without the pain.

[BEFORE SURGERY] HOST:

Before we can even get started replacing your joint, there are some very important tests and procedures you need to have done. Let's find out more from the woman who knows everything you need to do before your surgery, your Penn Preadmissions Testing nurse.

[PREADMISSION TESTING] PREADMISSIONS NURSE:

Hi I'm Kathy / Kathleen Dougherty, a preadmissions nurse at Penn Presbyterian Medical Center. Four weeks before surgery, it's very important for you to begin taking an iron and multivitamin supplement.

It's also critical that you come in for all of your scheduled preadmission testing. These may include some or all the following tests: a blood test, a urine sample, an EKG, blood donation, a medical evaluation by a doctor, and an admissions interview with an admissions nurse. I'll answer all of your questions and hopefully alleviate any of your fears.

The day of your preadmission testing you may want to bring a friend or family member to help you, a written list of all of your current medications, and your insurance card.

[BEFORE SURGERY] PREADMISSIONS NURSE:

The day before surgery, you need to call the Short Procedure Unit between 2pm and 4pm to confirm your surgery time and discuss any last minute questions. If your surgery is scheduled on a Monday you need to call the SPU the Friday before. And last but not least, you should not eat or drink after midnight the night before your surgery. This includes water, ice and gum.

[DAY OF SURGERY] HOST :

On the day of your surgery, you may be feeling a little nervous, and that's normal. Just remember that this procedure is going to help you return to a more comfortable and active lifestyle.

The day of your surgery you will meet with your anesthesiologist in the holding area to discuss the different types of anesthesia available to you. If you would be more comfortable discussing this ahead of time, we'd be happy to set this up for you.

In order to ensure your surgery goes as smoothly as possible, we need to review a few do's and don'ts. First, it's very important that you arrive at the Short Procedure Unit at your assigned time. Take the morning doses of your cardiac and blood pressure medications with a small sip of water. For insulin and diabetic medications, follow your doctor’s instructions. If you use an inhaler, bring your rescue inhaler with you. If you have any other medical conditions such as sleep apnea, please tell the preadmissions nurse and bring your CPAP machine with you to the hospital.

To make your stay more comfortable please remember to bring a bathrobe, any toiletries you desire, and sweatpants or loose fitting clothes for the day of your discharge.

In order to ensure your health and safety, the following is a list of what NOT to bring to the hospital. Try not to bring electrical items of any kind. Do not bring large amounts of cash, home medications except your inhaler, do not wear any jewelry and remove any piercings. Remove all nail polish and artificial nails.

[PREPARING YOUR FAMILY] HOST:

The day of your surgery you should have a friend or family member waiting for you. In order to keep them comfortable and informed, please advise them to wait in the surgical area where they may speak with the surgical team. They will also be able to track your progress using our Navicare system located in the family waiting area on the second floor. Your friends and family can expect to wait around 5 to 7 hours. So please tell them to bring a good book!

[AFTER SURGERY] HOST:

Once you’ve made it successfully through surgery, you're going to have a lot of questions about what is attached to you and your bed.
For answers to some of these questions, let's talk to Kaitlin / Kaitlin Baker, a nurse in the joint replacement recovery unit.

RECOVERY NURSE:

When you get through surgery, you'll be brought to the Post Anesthesia Care Unit to wake up. When you do you'll notice you have a variety of items on and around your bed. Let's walk through them.

Depending on the type of surgery you had, you may have various types of equipment such as a hip pillow to keep you comfortable if you had hip surgery. You'll have some polar care or ice bags for swelling. An IV will be in your arm so you can receive fluids and medications. These electrodes monitor your heart rate, and this pulse oximeter will monitor your oxygen levels. Compression stockings may be used for support and to avoid blood clots. This sounds like a lot of medical equipment, but it's designed to make you more comfortable and heal faster.

HOST:

Once you are fully awake, you will be taken to your room where you will begin your journey to recovery with the support of a highly experienced team. Penn Presbyterian has a co-management team approach which means you will have a team of doctors, nurses, residents and hospitalists taking care of you - changing your dressings, helping you start to move again and managing your pain. Together you will develop a plan for pain management, physical and occupational therapy, and preparing to go home.

[PAIN MANAGEMENT] HOST:

First let’s discuss pain management with Doctor Israelite.

DOCTOR:

After surgery you can expect to be in pain. It will hurt and it can be scary learning to move around on your new knee or hip. We know this. Talk to us about it. Each day a member of our team will visit with you and ask you to describe your pain on a scale of zero to ten - with zero being no pain and ten being unbearable. Based on your response, we'll make sure you get the appropriate amount of medication over the next three days. Controlling your pain is one of our main objectives. We will make sure you are as comfortable as possible...comfortable enough to begin physical therapy.

[PHYSICAL REHABILITATION] HOST:

I'm glad Doctor Israelite brought up physical therapy. After your surgery there are several physical therapy options available to you that will be prescribed by your doctor. To learn more let's talk to Marty/Marty Kelley, a physical therapist here at Penn Presbyterian.

PHYSICAL THERAPIST:

When it comes to physical and occupational therapy, it's important to remember that you are in control of your own recovery. The more actively you participate the better you will get. It is our intention to have you up and moving as quickly as possible. First we'll outline what you can expect while here in the hospital then we'll make a plan for your ongoing recovery. We'll teach you how to begin moving, how to wash and dress and above all else – how to move SAFELY. We’ll set goals and achieve them one by one.

[THERAPY OPTIONS] PHYSICAL THERAPIST:

Once you are ready to leave the hospital, you're ready for physical therapy. Right now there are four different levels of physical therapy available. They range from intense, 24-hour, inpatient care, to less intense physical therapy in your own home. The Discharge Planning Team will work with you to figure out what therapy type is best for you. It will be based on your health, age, medical needs, the type of joint replacement you are recovering from, your type of insurance coverage, and the support system you have at home. Together you and your doctor will develop a plan that works for you. If you are headed straight home from the hospital, your therapist will send you on your way with some helpful tools that will make getting around and remaining independent a lot easier.

[GOING HOME] HOST:

It's finally time to go home. Managing at home is going to be a little difficult at first. The following is a list of things you need to take care of before your surgery, so you can return to a manageable household. First, you'll need to set up a support system of family and friends that can help you with daily activities like driving and shopping. Next, be sure to stock your freezer with prepared meals or easy to prepare foods. Move everyday items like shoes, clothes, pots and pans and the telephone to convenient reachable heights. Avoid places where you will have to bend or kneel to reach something. You will also need to make a few adjustments to guard against injury. To decrease your risk of falling be sure to remove all throw rugs, tuck electrical cords out of sight, and keep the pathways in your home clear for walking. Next, let's talk about wound care. It is very important to remember that you have an incision in your skin from your surgery and caring for it is of the utmost importance. First, keep the incision clean and dry. You will need to refer to your discharge instructions regarding when you will be able to take a shower. If you notice any redness, swelling, heat or drainage from the incision, call your doctor immediately. And finally, Medication Management. In order to prevent drug interactions, it is imperative that you speak with your doctor about ALL of the medications you are taking – including the ones at home and the ones recently prescribed. Your care team will talk to you about the option of a Homecare nurse at discharge. Homecare nurse visits make recovery so much easier, no matter how good your personal support system may be. A homecare nurse does a thorough medical home assessment, checks your medications and helps you and family members with wound care.

[GET ACTIVE] HOST:

We're almost done with our presentation but before we go we want to share with you the single most important step you need to take after your joint replacement surgery: GETTING ACTIVE AGAIN. You've been living with your pain so long you might not even remember what it feels like to be active. The following tips will help you get active and stay active. Exercise daily – we recommend walking or swimming Maintain your ideal weight – weight gain will adversely affect the pressure on your new joint. Take precautions against infections - your new joint will be affected by any infection that gets into your body. You must take antibiotics before any dental, gastrointestinal or other potentially invasive procedure. Elevate your leg and apply ice for 20 minutes at a time to decrease swelling. It’s not unusual to experience swelling for several months.

[CONCLUSION] HOST:

Thank you for choosing the Penn Orthopaedic Team. No matter how good we are at what we do, you are the most important person in your rehabilitation and recovery. It's your continued commitment to regaining your mobility that will allow you to live a pain-free, active life for years to come. Your life is worth Penn Orthopaedics and we can’t wait to help you start living it again. For more information or a copy of this presentation please go to http://www.pennmedicine.org/orthopaedics.